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 Welcome to this Week in Health IT events where we amplify great ideas with interviews from the floor. My name is Bill Russell, recovering Healthcare, CIO, and creator of this week in Health. It a set of podcasts and videos dedicated to developing the next generation of health leaders. We wanna thank our founding channel sponsors who make this content possible, health Lyrics and VMware.

If you wanna be a part of our mission to develop health leaders, go to the homepage this week, health.com, and click on sponsorship information. This week we're at the health conference in Las Vegas, and one of the areas I'm keeping an eye on is dental medical integration. It's amazing really, that it hasn't happened in earnest yet.

I was able to sit down with one of the leaders in this movement, Pacific Dental Services founder Stephen Thorn and Dan Burke, the SVP of Platform Strategy to talk about this obvious in integration. Have a listen. Hope you enjoy. All right. Here we are again from the Health Conference in Las Vegas. We're here with the leadership or some of the leadership from Pacific Dental.

We have Dan Burke, the Senior Vice President of Platform Strategy, and we have Steven Thorn, the, you have a lot of titles, but President, CEO and Founder, founder, founder Pacific Dental. I, I'm really excited about this conversation for a couple reasons. One is. Uh, yesterday you had Bernard Tyson, CEO of Kaiser Permanente stand up on stage on the main stage, and he was talking about, uh, mental health, and he said, you know, in healthcare we've separated the head from the body.

And that's actually a phrase that I heard from your . CIO before, and, and as we've talked about it, it's like, you know, healthcare doesn't, hasn't for many years recognized, uh, oral systemic health as, as part of healthcare. But that's changing. I mean, and we're seeing that change, you know, Walmart's sort of integrated.

You're seeing some other neat, uh, plays, start to integrate it. And, uh, so I'm, I'm, I'm looking forward to having this conversation with you. And I think for our audience, I think they'd be surprised how, how much it's already starting to be integrated in terms of care model. So with that sort of as the backdrop, give us a little, a little background on Pacific Dental.

What the, what the model is, where you guys, uh, have been and where you're looking at going. Right. Thanks. Uh, we, we are a, uh, DSO. We support, uh, almost 800 practices around the country in 22. Dates in 40 different markets, about 3,500 clinicians out there working hard every day. So most of the carriers that are here and the the groups people are talking about here in overall in the overall health, uh, we work with today.

But it's exciting for us because we're the only dental company that is here, I believe. And so we, we see what's happening out there in the. What we call dental medical integration and the link between, um, oral diseases and systemic diseases. And so that's the primary reason we're here. That's exciting. I, and you really, you haven't found any other dental here?

I, I mean, I haven't, I've walked through the, the booth. I, I believe we're the only dental company here and it's super exciting. And, and we're, we're dedicated. This, uh, from a organizational standpoint, we are in the process of. Uh, migrating our whole practice management system over to the Epic platform, which is obviously integrated the mainstream, uh, overall health.

So we're excited about that. So you're gonna be able to see the, the, uh, wisdom, which is the Epic platform. You're gonna be able to see the is wisdom, uh, information right next to the, uh, . Medical information. Correct. In theory. And so, so many of the carriers, I say in theory 'cause it really hasn't been done yet.

Well it hasn't been done yet, but I don't, we will be the first, I'm going to throw it down there. We will be the first to have it actually integrated in the dental, in the wisdom product. But we're, we've been working on this for a couple years now, so with dental and medical integrated, integrated, we have three medical practices we support.

So it's not like we have to go out outside our system to make this happen. We're actually doing it within our current system. Yeah. And yours, yours is an exciting company. You guys believe in platforms, obviously you have a Yeah. A platform, um, title. Sure. Which is interesting 'cause I love that title. That, and it, it's a, uh, it's something that healthcare really should adopt.

Mm-Hmm. , I mean, I'm coming from the IT background and essentially saying, look. You know, they think, uh, E-R-P-E-H-R and you know, these are platforms, but they're not platforms, they're applications. It's still, uh, platforms are really a level above that and enable all sorts of agility. Um, but also the business model's thinking in terms of platforms.

So Walmart comes out with their Sure. And, uh. Whatever, Dallas, Georgia. Mm-Hmm. . A hundred thousand square foot facility. Mm-Hmm. . And they put mental health, uh, uh, primary care and dental. Mm-Hmm. as well as other things. Right. Uh, you know, uh, labs and other things. All in that same building. Mm-Hmm. . Um, is, is that the future of, of sort of what we're.

We're gonna be seeing is those kinds of entities popping up. Yeah. I think, and, and another example, Walgreens, I believe they have two or three in northern Florida now. They have, uh, dental practices right in the, in, in the pharmacy footprint. Uh, I think what we see is just starting from the patient perspective.

We think that's the big. That's why we're talking about platforms, because you guys have been retail for a long time. I mean, you, you guys are, I mean, that's your, that's your background. Yeah. We're in the neighborhoods. Yes. And it's a, it's called it a retail location. Uh, it's fully integrated, comprehensive oral healthcare under one roof, which has been a differentiator for PDS, uh, from the beginning.

Uh, Steve, when he started 25 years, or 25th year, by the way, uh, it was with the general practicing dentist. . But from the patient perspective, that dentist would bring in the specialist. So it's built out for oral surgery and then, you know, you name it, periodontist, endodontist, uh, board certified pediatric dentist orthodontist, they come there for the patient.

So from a patient perspective, in your neighborhood, you have comprehensive oral healthcare, which, uh, thankfully it's becoming less rare. Uh, I'd like to think PDS had a lot to do with that. And what's exciting for us now is we think, um, dental has been the ultimate in balkanized and separated. It's been completely walled off, uh, for generations and, and that's been fine, where dentists are by themselves.

They, uh, uh, literally are practicing by themselves and who can name anybody who's ever taken their dental records with them from one to the next. So it's been an incredibly inefficient system. So, PDS, when we think about platform, it's really about a mindset. And it, and the nice thing is that the science is catching up with PDSs mindset for 25 years, which is the mouth is part of the body.

And so these ideas about whether it be Walgreens or Walmart or whatever, it's the idea really is can patients be seen as a healthcare system of one and can be treated as a healthcare system of one? And it's this artificial balkanization of ourselves over. PDS says yes. That's why Vanguard partnered for, for Epic.

So yeah, we, we think that's, that's why platform, and again, for us it's a mindset and ultimately it's about the patient and so that the dentist can be part of the clinical collaborators for that one health system. One. So you, the interesting thing about your model, you guys really are. Everything. I mean, similar to healthcare, um, you know, you have the big hospital there, but you have all these entrants coming in and picking off this one thing or whatever.

But dental's sort of gotten there. You've gotten a lot of competitors that are doing new business models and those kinds of things. Um, but you guys are pretty, I mean, you guys are really coming alongside in all aspects. I mean. Uh, insurance all the way through, right. Um, all, all the different aspects of, of healthcare, right?

That's, that's been one of the biggest barriers. Dental has its own coding system, so much different than everything else in medical. And so it's like, uh, Chinese and Japanese, they don't really talk to each other. That's one of the reasons we're doing this big investment into the Epic Wisdom product that we talked about, right, is because now we can talk to each other and they will be working in the same patient record.

They'll have access to cross coding, cross billing. There are some carriers doing that right now. UnitedHealthcare and the Blue Cross Blue Shield of, um, of Hawaii and a couple others that are testing this and what we're, what . They've all shown, and I've yet to see, I was telling Dan just before we started talking that they've all shown an overall reduction in overall healthcare costs.

So as, as these carriers integrate dental in a more efficient and a more effective way into the overall healthcare, um, into their overall health plan, they're able to save. Overall healthcare dollars on an annual basis. It's a big deal. Yeah, no, I, I would think it is. So is your, you know, I, I sort of, you know, my knowledge of dental coming from healthcare is probably what you think it is.

And, and so I, I referred to you as retail earlier, but, uh, I mean, do you, um, do you go directly to employee. Employers, do you go, I mean, what did, what did, how do you, how do you market this? How do you, how do you help your, your practices succeed in their markets? We currently don't go directly to employers.

We have a, um, a dental plan for patients that are uninsured. That's a growing space for dental right now in the United States, but we mainly work with the, the large carriers of the United States. There's one, uh. Dental care that has the vast majority, it's called Delta Dental, right? But there's others that are, are also very large, Humana and United Healthcare and, and MetLife and those others, they're very large cares.

So we work with them. But more, more and more we're looking at what's the future? That's the past, what is the future? These sort of, uh, and I've heard a lot, I heard a lot yesterday about these, these kind of updated TPA type plans. I think that's gonna be a big part of the future of dentistry. Yeah. I think, bill, one thing that's really exciting is a lot of these things didn't happen in dental before.

Again, because of the incredible disparate Right, right. Nature of it. I mean, you couldn't coordinate . The individual dentist to do that. What's really exciting about PDS is now we're at the scale where it's really interesting. Uh, we have density. I mean, for the first time you have a dental company like APDS that can point to Nevada right here.

We can point to the Inland Empire in California. We can point to Colorado and Denver area. We can point to Arizona. And when we have density, now we're very interesting 'cause now you can talk to a hospital system and we, and we have worked with one hospital system in particular and one of those areas that I've spoken to.

And how do we work with them and integrate into them? Because then you can start going out to an employer and saying, we can cover all of your employees. We actually have a dense network, uh, to support it. So your, your model going back is you essentially came with. Dental practices traditionally have been like mom and pop shops.

Mm-Hmm. . Correct. And you came alongside of them as ADSO and provided all those services. Correct. Um, but now what you're talking about is if you, if you get enough aggregation of that, you actually have the ability to almost function like a system within that market. Correct? We do. We think the future will be that the aggregation in dentistry, when I, to give, put it into perspective on numbers

It's less than about 1%. When I started 30 years ago, PDS has been in existence 25 years. It's approaching 25% now across the United States. So it, it's aggregating very fast. And in those markets, Dan just mentioned, we have massive density. So if you think about, um, as an example, a Medicare Advantage program.

Yes. So why not do it if those are the dollars? So that's now possible. 10 years ago that wasn't possible. Uh, this is gonna maybe show my ignorance, but wondering why a health system hasn't bought companies like goers. VC is heavily into dentistry and the reason they are is 'cause it's. It's primarily a cash business, is what I've heard.

Mm-Hmm. . I don't know if that's true or not, but I've heard it's primarily a cash business and the margins are a lot higher than, than healthcare. I mean, when you look at healthcare, most of these large systems walk in here and they're, they're at 2% margins and, and dental is, is higher, but why isn't a health system like just said?

Hey, that makes a lot of sense. Is it just the cultural barrier? I, we think it's gonna happen. It's just a matter of when. I think part of it is just the maturity of the DSOs. A large health system is not gonna be interested in ADSO that's scattered around and has 12 practices. Right, right. Well, PDS, to give you a sense of our growth.

Uh, it probably took what just to, if you aggregate revenues and you think about that as our size, right? It took about 21 and a half years or so, Steve know enough to get to a billion. Well, we're budgeting, that was just a couple of years ago. We're budgeting for next year to be approaching 2 billion.

Right. So, and then we're gonna double again in four and a half years. Less so if you think about all, I'm the numbers guy C, he's the platform man. It just got harder to make my bonus right there, bill. You just saw that right in front of you. But it should, but it should accelerate you because of platform.

Exactly, yeah. And that's all organic. That's all organic. It's acquisition in there. That's a dentist saying to us, Hey, we want to help. I'm ready to open a practice and I want you to help me. And that's us going out, buying dirt, building it up and, and helping 'em out or finding him a lease space that's all de novo, all organic.

So when you start getting that kind of energy and that kind of scale, no question. Uh, and by the way, even just if you look at the maturity of the markets, even when I got to know Steve, I think we got to know each other about 10 years ago. I joined eight years ago. Uh, I guess over that now. Wow. But, um, the, the, the types of VC folks where Steve was describing the industry were perfectly very good vc, but they tended to be, uh, retail, vc, or some of the smaller niche healthcare VCs.

A few of the larger groups, but, but not too many now. It's the K krs, it's the, the ones that are involved, the Carlisle groups, you name them, they're all in and they're all at the gate. Waiting. It's just where can they deploy their money? Um, and candidly, uh, we, we think once they're large in scale, yeah, someone's gonna come in and we could all name the different groups.

That would be likely, but how could they not? A, it, it, it fits nicely. B, the numbers are clear. And, uh, like for, doesn't study an Avalara if someone wants to, to get a copy of it. That would show if, uh, patients on Medicare patients with certain systemic conditions and not. Not the whole list, just a brief list were to have a dental benefit just just tied to periodontal disease treatment.

For those patients with those systemic conditions, it would save $80 billion. I mean, it's remarkable. So once, once the payers start seeing that, or hospitals starts seeing that, it'll happen. Just right now, I don't think they've had a target to go after. Uh, they will, uh, it probably won't be us. We're the only one that's not owned by PE or.

vc. Nothing wrong with that, but we get to have, Steve and I won't go off on this, but that's a reason why people like me get to say to, I don't have to go to a board. I don't have to go to a PE group. I don't have to tell him that what's my turnaround in 12 months, which changes the game. Yeah. I don't need to make numbers next quarter.

I just get to say to Steve, Hey, here's an idea, and if Steve believes in it, we can do it. That's, uh, that's fascinating. But the, the, it really is fascinating 'cause the from, so you guys are at scale. You could, you're getting there. You could, uh, well, from this perspective call center, you have a centralized, massive, centralized call center.

Mm-Hmm. , massive centralized billing collection services. Mm-Hmm. . Right. And uh, phone system is now . We're all integrated across the entire network. Yeah. Yeah. We're on Ring Central. Yeah. Those are, those are, those are huge. Uh mm-Hmm. , huge movements. I mean, if I'm a small mom and pop shop and I'm going, all right, this is getting harder and harder for me.

I, I need, I need a way to engage patients. I need a way to keep my chair filled. I need a way to expand into new areas. I need a way to, I need a way to do all these things. Plus the phone system costs money. The, all this stuff, it's, it's hard for them to, to stay, stay going and stay. Alote, isn't it? Right.

And that's why the, uh, space is growing so fast across the nation. It's, it's, we're growing at a very nice pace, a very steady pace, good use of capital. There are other groups growing just as nicely also. In different, in different niches. I think what Dan said earlier is accurate. We're the largest full service group for all the different specialties, and I think that's enables us to move over to integrate better on the medical side than others could.

And we, again, that's what we see as a future. Mm-Hmm, . So what would a partnership look like? So I'm with a large health system. You have, uh, you have scale and, well, we talked about Nevada, Southern California. You have some scale. Sure. So I come to you and say, alright, let's, let's start talking about partnerships.

Um, is it, is it building out new, uh, new locations that sort of integrate it, or is there a way to integrate it in other ways? I think there's a couple different, different ways we've been thinking about it. The, uh, the, the simplest way is what we've done with, uh, another group in, in Arizona and just helping them with getting their patients that need our need dental care.

Over to our offices and for us with patients that come in that need a physician, get them over to see a physician, we see it on both sides. So just referral patterns. It's referral patterns. And we take dentists, take blood pressure, you know, just something super simple. Right, right. Elevated blood pressure.

Who's your physician? When was the last time you saw your physician? Well, here's a group we work with. You can get over patient walks into the, um, into the physician and . Has some inflammatory disease, whether it be diabetes, cardiovascular disease, uh, all, some mild Alzheimer's, whatever. Okay. When was the last time you saw your dentist?

Simple, simple things like that. Now, the next step is I think some where these groups have the full risk coverage of helping them actually reduce costs, and that gets to a whole nother level of thinking where we have, we have some density in those markets, and so I think . The, everybody wants this to happen.

So your question is, how would we work together? It's, it's going to happen because again, everybody wants it to, and I'll go start with the clinicians. Steve's on a, a, a board at Harvard on, or oral systemic health. So at Harvard, dentists and medical students take classes together. Now at NYU, they have to sit and take classes together.

At University of Pacific, they take classes together and they're building one clinic where the, where the dental students and the medical students will actually learn together and they will, this will be something they'll, they'll grab. Graduate and assume they'll be surprised that they, this always hasn't been the way for the profession.

Right, right. So from that perspective, from the patient's perspective, we all wanna be seen as a health system of one. Right. And where we've been building on the hospital system, I'll give you the real example, epic. It's, to my knowledge, it's a single largest investment that any company in the United Dental Company in the United States has remained.

You know, if you look at what we're projecting to spend on that thing over 10 years, it's, it's phenomenal. And candidly, we think it's a great investment. Of course. Uh, but that, that's just one . We're just naming Epic. It's not, doesn't sit on its own. Epic is surrounded by other aspects of our platform, all that have been specifically architected to be thin and open so that we could be a fungible puzzle piece and slide in and connect.

So not just referral. Once we're on the same system as these hospital systems and they have access to full data and they can get a more complete health history and what's happening, uh, with some of their patients, certainly with certain systemic conditions, they're gonna wanna work together. And the same thing

With a dentist and, and any hurdles in between. There are, I, I won't say they're, they'll be easy to get over, but we'll get over them because everybody on both sides of that chasm is pulling together to get over that thing. Yeah. What a, I went to a time management. Thing one time and, and, uh, somebody raised their hand and asked a question.

It's like, Hey, should I have one Daytimer for work and one for home ? And the person looked at 'em and said, one life. One Daytimer. And I think that the, the reason I I bring that up is. I, I, I own my own business. I go to do insurance and I have vision, which is one company I have Health, which is one company.

I have Dental, which is another company. Each one send to me a set of forms that I need to fill out, right? And I, I, okay, so I'm a very small company. I mean two people, two person company. And I have to dedicate almost a full day to like figuring out insurance for two people. And you're in the business.

Yeah, I understand that. Understand? Yeah. You sort of get it. Um, so we see the same thing. Yeah. There's, and there are companies out there. I think, um, again, uh, UnitedHealth and Aetna are both trying a couple things in that area to consolidate some of those. Now again, remember Dennis used a different coding system.

So there is a fundamental, fundamental different, different coding from what, from what spec, from a medical terminology standpoint. Correct. Okay. We have ACDT, common Dental Terminology, I think it's called, and ICD 10. Oh, okay. They're different systems. Got it. So, so dental hasn't been incorporated into ICD 10.

No, no, no. That's it. Now you're laughing at me like I should know that. No, no, no. I'm not laughing at you. I'm just laughing at it seems absurd how it's, and so that's part of that. Inertia. Dan was talking about that. It just keeps going. We're working on solving dentists currently. Uh, don't have to use diagnostic codes, which when you talk to your physician peers, they go, really?

Yeah. No, dentists don't use a diagnostic coding system, so we're trying to solve some of those big problems on scale. He's what he asked for though. No, I get it. A physician burnout on the other side because of I it. Mm-Hmm. . Just, and actually, if you step into healthcare, will you start to get more regulatory oversight and those kind of things, which may not be warranted?

I'm just curious. Yeah. It's a common question we get. Uh, and there's always that possibility of what, as it moves over to, um, uh, Medicare type . Not so sure on a Medicare Advantage plan because you're working with somebody that's above you taking the risk. Right. But you asked earlier about the, the payment system.

Six, uh, 85% of patients that come into our network this year, which will be over 6 million patient visits this year. 85% have a dental plan from a carrier, from a commercial carrier. Now 60%. Of the dollars that come into the system come from out of pocket. So there's a much higher, if you call it copayment or patient share in dentistry, than there is in on the medical side.

They're still accessing the dentist through their commercial dental plan of all the same carriers. So I think the, the, the risk is there. But if there's risk there, that's going to be vetted out anyway, it, it will happen. Because if there's excess profits in the system on dental, which I don't think there are, I think it's about fair.

If there's excess profits, it will get competed away sooner or later. Just the way business works. Right. What kind of things are you doing? I think there's some similarities and overlaps here, but what, what kind of things are you doing in terms of, uh, patient-centric outreach, communication, uh, reminders, those, those kind of things.

Um, how are you, how are you engaging the consumer? Sure. Uh, the most important engagement for the, for the patient happens at the street level. It is a local neighborhood dentist. Uh, so if your listeners haven't heard of Pacific Dental Services, pat on our backs, the ones we, we want dentists to have heard of us, not the patients.

So. When you go, in fact, some of your listeners probably go to Pacific Dental Services support practice. They should ask a dentist. Right, right, right. And then we think that's great. They should care about the name on the door, which is the clinician's name, right? That's the relationship we're trying to facilitate.

So that's the most important is in-Chair. Now, from there, of course, we support. Uh, a ton of communication. It's really however the patient wants it, right through a patient portal. It could be texts, it could be email, and all the, all, all the rest. Uh, in fact, we're excited 'cause we've done a pretty good job on that.

Epic's epic, quite frankly. State of the art and we're to, we're excited about, and I believe the name is going to be, um, MyChart Smile Generation, most part Smile Generation. We, we actually put, they, they asked us and we said, no, you guys go first. Because we're quite frankly, appreciative of how much they've invested in MyChart.

Uh, and, and, uh. But when, when patients have that, that that'll be a game changer in dental, that'll go to a whole other level. I think there's one other one is that people do want to get their teeth cleaned. Mm. And so the average patient, those, those numbers I was telling you comes in, they come in two and a half times a year.

And that's something they actually want. Now, they don't want a root canal and they don't want the other stuff, but the cleaning part. So it creates this, this recurring stream of patients and access and the. Ability to intervene early and from a business standpoint, nice recurring revenue stream. Yeah, I'd say one of the cooler things on patient engagement recently, I'll just give an anecdote, is, you know, uh, not that long ago I'm driving to work and I was talking to my mother and she's uh, in Boston and she tells me, oh, you're not gonna believe this.

My cardiologist asked if I've gone to the dentist 'cause she has a heart condition. And I, you know, of course I said, you haven't been listening to me for eight years, mom. Anyway. But I think that's happening as well. And it's, I think patients, candidly, I think a lot of people, and, and I'm probably on that list, thought there'd be more resistance to that idea.

And I think patients have immediately adopted it. I think intuitively they get it. Of course, the disease of the mouth or maldy of the mouth will impact the rest of the body. Of course it does. Yeah. So candidly, we haven't found that it takes a phone book of information. No. Uh, to convince a patient of something they already

Assumed in our, in our initial practice that we did the integration, we had 372, I think was the number of patients that were seen by both the physician and the dentist and Dan's spot on. It wasn't getting the, the patient to understand that the mouth was connected to the body. It was the dentist and the physician that we had to work so hard at.

Yeah, that's such, and I would, I would assume these . Integrated medical record now that, I mean, as you guys are talking about sitting there going, yeah. You know, I think I, it's better for me if my dentist knows the meds that I'm on and they know my medical history. Right. I mean, I, I, I don't expect them to do something that's gonna impact me that greatly, but, um, but I want them to know that they will, they use anesthesia.

Oh, they, they should know all that stuff. Of course, they shouldn't rely on a patient with a clipboard and a pencil going down and checking off the little boxes every time. Right. Yeah. I think we're gonna be kicked out. Out here in a second. So . Sure. Um, gentlemen, thank you very much. Okay. Thank you. This was really enlightening.

Absolutely. I appreciate being able to share. Thanks, bill. Thank you. I hope you've enjoyed the conversation. If you would like to recommend a guest or someone to be on the show, you can do that from our homepage. Uh, recommend a guest. It's about three quarters of the way down on the homepage. Please check that out.

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